He’s sitting on the toilet in his underwear, and he’s dead.

“When did you last see him?” I ask the lady who greeted us at the door.

“Five minutes ago, he got up to ho to the bathroom.”

He’s old, and frail, his skin so dry it flakes into the toilet when I try to rouse him. There is no pulse, but he’s warm. Small chance, but a chance is a chance.

“Harv!” the lady shouts from outside the door. “Harv! get up!”

It takes a minute to get him off the toilet, onto a board and compressions underway. I decide to work the code in the truck enroute to the hospital.

“Take him to the VA!” his wife shouts as we carry him out, “his doctors are all there.”

A guy about my age shows up as we carry his dad out. I explain the seriousness of the situation to him and tell him we’ll be going to the closest hospital which is far better equipped to handle sudden cardiac arrest.

“Do you have an ID or medical papers handy,” I ask as we pass him. He says he’ll look.

Five minutes into the code, the man’s wife tells us to stop pounding on her husbands chest. We are nearly at the hospital now, two shocks administered along with an amp of epi.

“I have paperwork!”

“Keep going,” I tell the guys who want to stop as much as I do.

“Stop!” says the wife from the front seat.

It’s 0300, the ER is quiet. We wheel our patient in, and directly to the code team. One of the doctors asks, “What’s the story?”

As quickly as I can I give the time table, vital signs and our interventions, then put the folder that was handed to me half way there on the triage desk. Inside is a half finished DNR report, along with a Comfort One bracelet. Also, records indicating the man is a stage 4 lung cancer patient who wanted to die with dignity, at home.

He didn’t.

I really can’t wait for this shift to end.

This time, I’m going to make a difference. Everything is working, the family called 911 five minutes after the symptoms began, Engine Company 11 arrived three minutes after that, oxygen was administered immediately, vital signs and neurological function assessed and a report transmitted to me.

This time, everything is going my way, the family has her medications ready, the stair chair is assembled, the patient lies in bed, unable to speak, eyes fixed to the right, facial droop, nothing on the left side. I’m not waiting, I don’t care about my back. I’m closest, I reach into her bed and pick her up and place her in the chair.

She’s fifty-five. A year younger than my mother was on her last day as a functioning person.

This time, this patient will get to the hospital quickly, and this time the medications that will restore her functions will be effective, and she will regain her mobility, and her ability to communicate, and this time she won’t spend the last nine years of her life in a nursing home, half alive, mind sharp but body unable, days and years of steady decline as the family watches her waste away until eventually the feeding tube goes in, and the light in her eyes goes out, and she dies slowly, a week before Christmas.

Not this time.

This time we are in the trauma room, half an hour passed since the onset of symptoms, and of all the doctors who could have been working, this time it’s the one I like more than all of the others, and she just happens to speak fluent Russian, the same language as the lady having the massive stroke. The doctor is able to communicate with the patient, and calm her a little, and figure out what is going wrong. She calls her mother from her cell phone, and finds the Russian word for “Stroke.” A mother daughter connection in the trauma room. This time everything is going to work out well.

This time I sit and watch, a front row spectator as the fifty five year old lady gets a second chance.She’s a candidate for TPA, which I have seen work miracles.

This time I don’t forget about the patient nearly as soon as the triage nurse signs my report. This time, every time I return to the ER with a different patient I check on her, and watch, and talk with the family, and offer encouragement.

Three times everything was going as well as could be expected, her vital signs were stable, the medications doing their job.

This time she is on a ventilator. Now she’s critical. She had a seizure, and her heart stopped, and they worked a code, and the family is looking at me, and telling me they don’t know what is wrong, and they hope I have some answers.

This time, I don’t have any answers, or encouragement, or much of anything. This time it’s all I can do to get through this shift.

Treatment of Ischemic Stroke

The treatment of ischemic stroke aims to dissolve, remove, or shatter a blood clot that is preventing blood from reaching an area of the brain. The most common treatments forischemic stroke are the following:

Intravenous TPA
This is the first line of treatment against ischemic stroke. Tissue plasminogen activator or TPA is injected into the bloodstream through an intravenous line. TPA travels in the blood until it reaches the clot that is causing the stroke. Once there it begins to break up the clot until blood can flow past it toward the affected areas.